The promise of lust

Partial list of side effects from citalopram information sheet I don’t know exactly when it shifted, and I definitely don’t know why. I tend to put a definite cut off around 2008, since the 2008-09 episode was so profound, lasted so long, and smothered me; like sleep, under morphine.

At first I blamed the drugs. That was comforting and easy, because after all a side effect of SSRIs is loss of libido. It also held out the promise that once I was off the drugs, I’d be up and running again. I was willing to put up with a flatlining sex drive for a while, for the relief the antidepressants gave me. They were only temporary, after all.

And then I came off the drugs, and I looked forward to the promise of torrential lust. Being young and gay in London with no strong desire for sex is… frustrating. I wanted that part of my life back. So I waited, and I waited, and it never came.

Oh sure, I could get drunk and horny. But that’s missing the point, isn’t it? Drunken lust is clumsy, grasping and loose. Temporary, and soon forgotten. Being young and gay in London with no strong desire for sex is more than a little alienating.

I still blamed the drugs, or maybe I blamed the depression, or both. Blamed some kind of permanent rewiring of the circuits of sexual desire. Maybe they’d burned out? Maybe they’d atrophied? We live in a culture saturated by sex – gay subcultures especially are sodden with it. But for all that, we seem to have little real regard for it. For most of us, sex is important, beyond hedonism and lust and beyond even passion. It’s important for contact, for happiness. For relationships and belonging and feeling a broad and deep range of emotion, sensation.

And I wasn’t getting any.


“Loss of libido” is thrown away in the patient information sheet which details side effects of SSRIs, alongside “failure to reach / maintain an erection (in men)”* and “Anorgasmia (failure to reach orgasm)”. I guess in the grand scheme of things, these aren’t profoundly worrying side effects – the other drug I’m on, lamotrigine, lists Stevens-Johnson syndrome (a potentially fatal loss of skin) and disseminated intravascular coagulation (DIC, AKA Death Is Coming) as it’s potential side effects. Yes, I’d rather have no sex drive and shit orgasms than die horribly from my skin sloughing from my body. Still. Hardly a fair comparison.

Sex is important. And when you’re prone to depression, not having a full – or any – sex life, and thus no romantic life, is dangerous. It denies you a source of pleasure, emotional soil in which to grip your roots to the world. “Protective factors”, in the dry but honest language of a psychiatric consultation. The fewer roots you have the more likely you are to wither. The easier it becomes to simply take the hand you’ve been dealt, and fold.

Sex is important. I really, really don’t think the wider psychiatric community appreciate just how important it is, largely oblivious to how antidepressants can deeply wound a life.


Of course, I’m human, and humans excel at making simple things complicated. Maybe the depression led to a plummeting libido. Maybe SSRIs turned down too many switches inside my head. But people are more complicated than just brains. After so long without a shag, the whole issue takes a life of it’s own, entwining with sexual confidence and body confidence, until it becomes impossible to know if you’re not having sex because you don’t want to, or because you’re afraid to.

I hope this problem is nice and simple and neurological. I hope my bottomed out libido can be blamed on a zapped out reward pathway, or a scrambled endocrine system, or anything other than high level psychology. Because if it’s up to psychology, I really can’t see it being resolved any time soon. Sex is important. Without it I don’t meet guys, I don’t date. I must be the only gay man in London who has never met anyone off Grindr. Seriously. My last online hookup was in 2008. This. Is getting. Tiring.


“Would you be open to a mood stabiliser?” The psychiatrist asks.

I’ve been rumbled. They want to take the hypomania from me.

“Which one?” I ask. They know I study neuroscience. It’s in the file. An awful lot is in the file.

“Lamotrigine”

I’ve heard of it, but beyond it being a mood stabiliser I know nothing. I don’t want the sluggishness that can come with some psychiatric meds (paroxetine destroyed me with sleep; and I’ve seen the effects of olanzapine – an antipsychotic – second hand). Will it place a final nail in the coffin of my libido? I’m wary. I want to know it’s mode of action, I want to know if…

“Like I say; I think the SSRIs work because they make me slightly hypomanic. If you take that away… What’s left?”

He reassures me; “just a trial”

It’s ultimately up to me. Naturally I go online and look up the mode of action (voltage gated sodium channel blocker, calcium channel blocker, glutamate modulator). I look up personal experiences.

Rise in libido.

Not everyone, not all the time. And sometimes the reverse – maybe it could be the final nail in the coffin. And sometimes the rise is due to activation of mania, sometimes fades after a few weeks. Still. It hangs there, glowing on my iPad screen. The promise of lust. Rise in libido.

I say yes.

I take the pill.


*Seriously, this is how it’s phrased. I love the fact they felt the need to specify.

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Loose boundaries

The psychiatrist eyes me over his glasses, notepad in hand. The day is too bright, the room too noisy, even in silence. Me, a social worker, a trainee clinical psychologist, and the psychiatrist. He seems affable; in my memory he has a short beard, a stereotypical shrink. But memories are unreliable, and my memory of this time more unreliable than most.

“You’re right”, he comments, “SSRIs have, in general, only slight efficacy. It depends on the person and their situation, obviously. We don’t really understand it.

But it seems, from what you’ve said, that they affect you a great deal more than most”

Generally, I take this to be a good thing.

*

My alcohol consumption has rocketed.

Normally I drink only at weekends, a few glasses (OK, bottles) of wine with a meal, with friends. If we’re going out, obviously I drink more, but again this is a weekends thing.

And I have a curious relationship with alcohol, in that it reliably makes me feel good. Yes, I can get maudlin, but warmly so. Even in my depression, it can lift me. Fact is, I enjoy being drunk. And I thank whatever guardian angels I have that, for some reason, this has never quite twigged with my subconscious. When I’m depressed, I don’t drink – I drink socially, I drink randomly, but I never drink to get happy. I never self medicate.

Which is why it’s curious that my consumption has rocketed. And I’ve got to put it down to the meds. SSRIs actually make most people more sensitive to alcohol, so you’d expect they’d drink less; but while I do get more sensitive, I end up drinking more. Lunchtime pints, nipping in to the pub after lab, staying for one more, one more, another more, more.

And it’s impulse control. I somehow lose impulse control on these drugs. I get some of it back after a few weeks, but initially there’s this loosening of my behavioural boundaries. Curiously, this is one of the mechanisms by which SSRI medication is presumed to trigger suicide behaviour (don’t worry, that’s not going to happen). It’s also something which alcohol itself disrupts – which is why drunk people can be so, well, impulsive. I don’t pretend to know the ins and outs of it (and I doubt anyone does), but it’s strange to watch yourself from the outside, behaviour staggering more than you’d anticipated, willpower veering, only half in control. Sober, acting drunk.